Acute Leukemia with a Focus on WHO Classification

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Author: Margaret Reinhart, MS, MT(ASCP) Reviewer: Rory Huschka, M.Ed., MT(ASCP) and Laurie Bjerklie, M.Ed., MT(ASCP)

This course compares and contrasts acute forms of leukemia based on the WHO classification system for acute leukemia. The most recent updates from WHO are incorporated in the course.

Continuing Education Credits

Objectives

  • Define acute leukemia and how it is differentiated from chronic leukemia.
  • Describe the various causes and risk factors of leukemia, as well as the pathophysiology of the disorder.
  • Differentiate between acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) regarding causes, patient populations, symptoms, and prognostic factors.
  • Identify criteria by which we classify acute leukemias and how the current WHO classifications differ from the previous FAB classifications
  • Describe the major WHO classes of acute myeloid leukemia (AML) as well as criteria that differentiate them.
  • Differentiate and describe the diagnostic techniques and criteria among the major acute myeloid leukemia (AML) groups.
  • Differentiate and describe the criteria and diagnostic techniques among the major acute lymphoblastic leukemia (ALL) groups.
  • Describe the major WHO classifications of acute lymphoblastic leukemia (ALL), patient populations, and prognostic factors.

Course Outline

  • Definition and Differentiation of Acute Leukemia from other Neoplastic Disorders.
      • Definition and Differentiation of Acute Leukemias from Chronic Leukemias
      • Definition and Differentiation of Acute and Chronic Leukemia continued
      • Characteristics of acute leukemia include all of the following EXCEPT:
  • Causes and Risk Factors of Acute Leukemia
      • Causes of Acute Leukemias: Triggers of Genetic Changes
      • Types of Genetic Changes in Acute Leukemia
      • Occurrence and Frequency of Acute Leukemia
      • Match the genetic or chromosomal abnormality to its definition:
  • Introduction to the Classification and Diagnosis of Acute Leukemia
      • Classification Systems
      • Initial Diagnostic Tests and Samples
      • Distinguishing between Acute and Chronic Leukemia
      • Differentiation between Myeloid and Lymphoid Lines
      • Cytochemical Tests Used in Differentiating Myeloid Cells from Lymphocytic Cells
      • Differentiation between Myeloid and Lymphoblastic Leukemias Using Cluster of Differentiation (CD) Markers
      • Which of the following cytochemical stains would yield a positive result in AML?
      • The World Health Organization (WHO) classification system relies solely on cell staging, cell morphology and cytochemical stains.
  • Acute Myeloid Leukemia (AML) Diagnosis
      • Signs and Symptoms of AML
    • 2016 WHO classification of AML
      • Complete WHO AML Classification
      • Interpretation of Genetic Designations of the AML Subtypes
      • AML FAB Classification
      • Occurrence and Common Types of AML
      • Match the abbreviation found in the WHO AML designations with the meaning of the designation:
      • The WHO classification of AML can be based on all of the following criteria except:
    • AML laboratory testing
      • Basics of Laboratory Testing
      • Cytogenetic Analysis
      • Molecular Genetics of AML
      • Karyotyping used in the diagnosis of AML refers to:
      • Mutations that cause AML generally are to the genes that regulate which of the following?
  • AML Prognosis and Treatment
      • Prognostic factors of AML
      • Types of AML treatments
      • Newer treatments
      • Method of AML treatment
      • Prognosis of AML
      • Important factors which can help determine a patient's prognosis of AML include all of the following EXCEPT:
      • What is the mechanism of action of chemotherapeutic drugs known as alkylating agents?
  • Acute Lymphoblastic Leukemia (ALL) Diagnosis
      • Signs, symptoms, and background of ALL
      • Diagnosing ALL
      • Adults rarely get ALL; it is typically only found in children.
    • 2016 WHO classification of ALL
      • Complete WHO ALL Classification
      • FAB Classification
      • All of the following are classification criteria in the WHO classification system of ALL EXCEPT:
      • An essential point of differentiation in the WHO classification system of ALL is whether the disorder is a leukemia or lymphoma.
    • ALL laboratory testing
      • Determination of ALL Lineage
      • Chromosomal Analysis
      • Genetic Analysis
      • A three year old has been diagnosed with ALL. Chromosomal analysis performed on this child's lymphocytes showed 53 chromosomes. A true statement about...
  • ALL Prognosis and Treatment
      • Prognostic Factors for ALL
      • Common Cytogenetic Abnormalities and their Prognosis
      • Treatment of ALL
      • The Future of ALL Therapy
      • A three year old is diagnosed with ALL. Choose the characteristics which would yield the most favorable prognosis for this child. Check all that apply...
  • Acute Leukemia of Ambiguous Lineage and Blastic Plasmacytoid Dendritic Cell Neoplasm
      • Acute Leukemia of Ambiguous Lineage
      • Blastic Plasmacytoid Dendritic Cell Neoplasm
      • Acute leukemia of ambiguous lineage (ALAL) is a common leukemia in which the lineage can not be specified or which shows features of both lymphoid and...
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: Laboratory personnel who are involved in hematology testing including technologists, technicians, laboratory managers, supervisors and laboratory directors. Also useful as a review for MLS students and those who plan to work in hematology after having been away from the department for several years.  
Author Information: Margaret Reinhart, MS, MT(ASCP) is senior lecturer in Biological Sciences at the University of the Sciences in Philadelphia PA and was the MLS Program Director of Medical Laboratory Science from 1990 - January 2020. She currently teaches hematology, clinical immunology, parasitology, and other related courses. She is also adjunct MLS instructor in Hematology at Pennsylvania Hospital (University of Pennsylvania Hospital System), Philadelphia PA. She holds a Masters Degree in Biology and in Health Care Administration.
Reviewer Information: 
Rory Huschka, M. Ed., MT(ASCP), has over 20 years of combined experience as a Medical Technologist, Technical Supervisor, Professor, and Manager. He is the former Director of the Clinical Laboratory Science and Medical Laboratory Technician Programs at Brookline College. He is currently a Program Director at MediaLab, Inc. Rory holds a BS degree in Medical Technology from North Dakota State University and a Masters in Educational Leadership.
Laurie Bjerklie, M.Ed., MT(ASCP), is currently a professor at Rasmussen College in Fargo, ND for their MLT program where she teaches a variety of courses including hematology and microbiology. She is the former Program Director of the Clinical Laboratory Science program at DeVry University in Phoenix, Arizona. Ms. Bjerklie has over ten years of experience in higher education and continues to work part time as a bench tech.

This course is part of:
Auer rods2
translocation t(8;21)
Acute lymphoblastic leukaemia smear B cell acute lymphoblastic
<strong>Chronic myeloid leukemia</strong>
Philadelphia Chromosome: used with permission from Macmillan Cancer Support
AML-M2 associated with a t(8;21) chromosome abnormality
A karyotype of a male with t(6;9)AML (9).
ALL pg39